Coding & Clinical Documentation Audit

TriumpHealth offers coding and clinical documentation audit services to detect bottlenecks, streamline the billing processes and help fill in the gaps. Our auditing services include reviewing coding documentation and fee schedules, analyzing the payer reimbursements, identifying the trends and root causes for claim denials, and training the billing staff with process improvements and best practices.

Our highly skilled and experienced staff are certified, and each has a minimum of 5 years of experience in the specialty that you require. We provide assistance to individuals and groups of providers within 57 specialties and 14 facility types. For each of these specialties/facility types, we will request documents such as the following to complete audits:

  • Copies of dictated or handwritten narrative operative/procedure reports
  • Medical records
  • Patient demographics
  • Copies of the claim form for each case or encounter reviewed

TriumpHealth’s expert staff will review medical records to analyze the accuracy of the procedural and diagnostic coding provided. Each review will include a case-by-case coding analysis that will compare your original coding with our experts’ coding. Areas of focus include incorrect code selection, unbundling issues, missed coding opportunities, code assignment that is not supported by documentation, code order, modifier usage, and documentation deficiencies.

When necessary, TriumpHealth’s coders and auditors will also code medical services for you by applying the appropriate CPT-4 procedural codes and ICD-10 diagnostic codes, along with any applicable modifiers. Variances will be provided in a written summary and an account manager assigned to you will be available for a scheduled call to review our findings. We also offer time with an individual or small group of providers who wish to review the results of their coding review and/or receive provider documentation and code selection training services remotely with a coding and documentation specialist.

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